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wound care exam 2 > Wound treatments > Flashcards

Wound treatments Flashcards

1
Q

Methods of debridement

A

Selective: Sharp
Autolytic
Enzymatic
Biologic

Non-Selective:
Mechanical
Surgical

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2
Q

Sharps Debridement

A

Selective
Aggressive
Possible pain

Not appropriate if insufficient vascular supply or poor nutrition.

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3
Q

Sharp debridement termination

A 
Clinician fatigue
Excessive pain
Decline in status/tolerance
Extensive bleeding
New fascial plane
No more necrotic tissue
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4
Q

Autolytic Debridement

A

Natural degredation of devitalization
Conservative
Little pain
Slow

Not appropriate with infection or arterial insufficiency

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5
Q

Enzymatic debridement

A

Use of enzymatic ointments to loosen and remove devitalized tissue and protein

Papain-Urea
Collagenase
Sometimes slow
Non-selective
May be painful
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6
Q

Enzymatic Debridement procedure and termination

A

Termination: failure to decrease necrosis or necrosis resolve.

Procedure: prescription needed.
cross-hatch first.
moist environment

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7
Q

Biologic debridement

A

Larva: sterile, lab-raised maggots.
Requires 2* dressing.
Selective
Can reduce bacteria

Seldom used in US

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8
Q

Mechanical Debridement

A

External force to non-selectively remove necrotic tissue

Painful
Can cause bleeding

Gauze, pulse lavage, whirlpool, wet to dry

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9
Q

Surgical Debridement

A

Physician: extensive exploration of wound bed and deep debridement

For: ascending cellulitis, osteomyelitis, undermining

Necrotic tissue near vital organs

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10
Q

Goals of debridement

A

Promote wound cleansing to remove debris and necrosis.
Reduce bacterial bioburden/risk of infection.
Promote optimal enviroment for wound healing.
Promote inflammation to facilitate angiogensis.

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11
Q

PT documentation

A 
Must have script
Selective vs non
Conservative sharps only.
Type/amount of necrosis
Insturments
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12
Q

Contraindications

A

Dry gangrene
Intact eschar s drainage, erythema or flatuance or poor circulation
Unidentified structures in wound bed

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13
Q

Whirlpool

A

Benefits: cleanses wound, promotes circulation, promotes debridement

Precautions: malignancy, promotes edema, can cause trauma to healthy tissue, avoid in diabetic wounds

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14
Q

Whilpool Risks

A

Infections: contaminated water, cross contamination
Superhydration/maceration
Changing of skin pH

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15
Q

Hydrotherapy considerations

A

water temp: 80-92, 92-96, 96-104
Dependent position
Duration
Addatives

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16
Q

Pulsatile lavage

A 
Promotes local circulation
Reduces bacterial load
Healthy debridement if using high pressure jet
5-15 psi.
Wear protective clothing
17
Q

Pulsatile Lavage

A

Reliable alternative to whirlpool
Minimal risk of cross contamination
Eliminates dependant edema issues

18
Q

Wound Irrigation

A 
Syringe vs gauze: 35 ml syringe
Irrigate with dressing changes
Saline
Wound cleanser
Betadine
Hydrogen Peroxide
Dakin's
Acetic Acid

4-15 psi

19
Q

Electrotherapy

A 
Increased perfusion
Stimulates fibroblasts
Increases tensile strength
Antibacterial
Debridement effects
Migration of inflammatory and repair cells
20
Q

Current of injury

A

Electrical potential across skin
Current disappears with regeneration of tissue.

Positive polarity: coagulation of protein, hardening of tissue, coagulation of blood, enhancing scar formation

Negative polarity: liquefying protein, softening tissue, bactericidal, debridement

21
Q

US

A

Stimulates release of chemoattractants by fibroblasts, mast cells, and macrophages.
May stimulate fibroblast proliferation for collagen deposition, angiogensis, and wound contraction.
Increases wound tensile strength.

22
Q

US contraindications

A 
osteomyelitis
active bleeding
severe arterial insufficiency
acute DVT
untreated acute wound

consider poor ability to penetrate eschar

23
Q

Wound Vac (negative pressure therapy)

A

Increases perfusion to wound: increases o2 and nutrients
Helps drainage control
Change dressing every 48 hrs

Decreased edema, increased blood flow, decreased bacteria, more granulation tissue, promotes epithelialization

24
Q

npwt indications

A

Arterial, venous, pressure, mixed vascualr ulcers, dehisced surgical wounds, wounds with tunneling/undermining, assist flap survival

Not indicated for wounds with 20%+ non viable tissue

25
Q

NPWT contraindication and precaution

A

Contra: malignancy in wound, untreated osteomyelitis, unexplored fistula, eschar, exposed vessels/organs

Precaution: bleeding, anticoagulants, proximity to vessels, organs, bone, and enteric fistula

26
Q

MIRE (anodyne)

A

Photo energy that produces NO in hemoglobin to reoxygenate wound bed.
Vasodilates

27
Q

Hyperbaric o2

A 
Full body or multiplace
100% o2 at high pressures
Daily or BID
Promotes angiogenesis and o2 perfusion
Restores pH
28
Q

HBOT indications

A

Grade 3/4 diabetic ulcer, compromised skin graft, radionecrosis, arterial insufficiency, crush injury, necrotizing fasciitis, gas gangrene, chronic osteomyelitis

29
Q

Compression

A 
Reduce/control edema
Base of toes to knees
Distal to proximal
ABI greater than .6-.8.
Precaution: CHF
30
Q

Compression classifications

A

1: 14-18=edema prevention, DVT prophylaxis
2: 18-24: dependent edema
3: 25-35: venous insufficiency
4: 40-50: lymphedema

31
Q

Bioengineered skin substitutes

A

Apligraf: cultured from newborn foreskin, replaces dermis and epidermis
Indicated for non-infected venous ulcers
Dont use with bovine alergies

Dermagraft: derived from human fibroblast, replaces dermis only

32
Q

OASIS

A

from pig small intestine submucosa

collagenous ECM c cytokines

temporary dressing for partial and full thickness wounds

hydrated on application

33
Q

Topical growth factors

A

from recombinant human platelet derived growth factor

expensive

wound care exam 2 (4 decks)

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